Knee Replacement Results Improved By Computer Navigation

Posted on June 19, 2015.

For Immediate Release CONTACT: Amanda Maselli New Hampshire Orthopaedic Center 603.883.0091   KNEE REPLACEMENT … Read More

Dr. Sinkov – On Call with the NH Medical Society

Posted on May 15, 2015.

If you weren’t able to catch Dr. Sinkov’s May 13th ‘On Call with the NH Medical … Read More

We Made New Hampshire Magazine’s ‘Top Doc’ List for 2015!

Posted on March 20, 2015.

We are proud to be included in New Hampshire Magazine’s Top Doctors for 2015!  Congratulations … Read More

New Hampshire Orthopaedic Center

Runner’s Knee

Posted on August 5, 2015.

By: Anthony R. Marino, MD

Runner’s knee, also called patellofemoral pain syndrome (PFPS), is an irritation of the cartilage or tissue underneath the kneecap or the patella. The majority of running injuries are knee injuries and 50% of runners over time experience knee pain. PFPS typically flares up after long runs, when you’ve had to sit at a desk for an extended period of time, or while going up and down stairs or hills. During these activities, extra-load or biomechanical factors impact your knee.Risk factors include flat feet, and muscle imbalance around the quads, hips or knees.

Training Modifications for Runner’s Knee

Like most running injuries, this is the type of injury that you could run through, but reducing your mileage is generally necessary. Avoiding hills can also help you continue running. Cross-training, bicycling, elliptical training, and swimming are knee-friendly activities that should be added to your rehab.

Rehabilitation for Runner’s Knee

Physical therapy is a very important part of the rehabilitation of this knee problem. The large majority of patients improve with formal physical therapy which strengthens the muscles that help realign the kneecap. It is possible to get back into running, as long as you start slowly, increase your running program gradually, and continue to strengthen the muscles around the kneecap.

When to Stop Running and Visit and Orthopaedic Surgeon

You need to stop running and visit an orthopaedic surgeon if you experience severe pain on the inside or outside of the knee or feel like your knee is buckling, catching or giving way. Like most common running injuries, runner’s knee is generally managed non-operatively. We use physical therapy, nonsteroidal anti-inflammatory drugs, and activity or training modification to help get patients back on the road.

Preventing Heat Stroke

Posted on July 27, 2015.

Scott M. Evans, PA-C

Now that we’ll be experiencing the heat and humidity of summer, it is very important to understand the symptoms of heat stroke and how to prevent it. Heat stroke is a very serious and potentially dangerous injury that requires medical attention immediately.

Heat stroke is the most severe of a group of heat-related illness including heat cramps and heat exhaustion. The definition of heat stroke is a core body temperature that reaches 105 degree Fahrenheit or higher combined with central nervous system breakdown.

Signs and Symptoms of Heat Stroke

Here are some of the signs and symptoms of heat stroke that you need to be aware of:

  • At the beginning stage of heat stroke the skin can became warm to touch, however once the body’s central nervous system is involved, the skin can feel cool and clammy. 

  • Hot, red skin is one of the most common signs of heat stroke. If your skin is hot to the touch and you have an internal body temperature of 105 degrees or higher you need to get medical attention.

  • Dizziness, fainting and confusion are the next most common symptoms of heat stroke.

  • Nausea with or without vomiting – especially combined with dizziness – are other indications that heat exhaustion has progressed into heat stroke.

  • If your heart feels different or ‘funny’, you may be experiencing tachycardia (heart rate above 100 beats per minute).  Tachycardia must be addressed before returning to activity.

  • One of the differences between heat exhaustion and full-blown heat stroke is a lack of sweating. If you’re suffering from heat stroke, you will not sweat.

  • You may experience a severe headache or even have a seizure.

Preventing Heat Stroke

Prevention of heat stroke is easy if you are proactive:

  • Stay hydrated

  • Take breaks often

  • Avoid activity from 11:30am-2:30pm

  • Wear breathable clothing
In poor air quality and high temperatures, avoid outdoor activity

Afraid to Have A Knee Replacement? You Are Not Alone

Posted on July 16, 2015.

By: Kathleen A. Hogan, MD

Each year, over 700,000 total knee replacements are performed per year in the United States. Many people who have arthritis can have pain relief with non-operative treatments such as weight loss, braces, activity modification, medications, and injections. But when these treatments are no longer effective, joint replacement is often recommended. However, some people delay or avoid surgery, despite being in pain.

Common Reasons People Are Afraid to Have a Knee Replacement

There are some common reasons that people are afraid to have a knee replacement. Fear of pain is usually the top reason. Concerns about missing work or important events is the second most cited reason to delay surgery. Some people feel they are too old for surgery. Others worry about complications of the procedure.

Managing Pain

Knee replacement is a painful procedure. Bones are covered with a thin layer of tissue called periosteum which contains nerve fibers. During a knee replacement, the bones are cut and this causes a painful inflammatory response. To prevent pain, the best treatment is to be proactive. For example, my patients usually take an anti-inflammatory medication 3 days prior to surgery. A nerve block is given before the surgery and local anesthestic agents are placed within the joint during the surgery. Some medications, such as tylenol and toradol are given around the clock after surgery, and narcotic pain relievers provide additional relief as needed. This multi-modal pain regimen provides excellent relief of pain, but the knee will still be stiff and sore. The pain is at its worst during the first few days after the surgery and then improves.

Returning to Work

Returning to work after surgery is dependent on the requirements of the job. However the first 2-4 weeks you should concentrate on feeling better and working with physical therapy. If your job does not require much standing, lifting, or climbing, you may be able to go back to work in 6 wks; more strenuous jobs will require more time off. Everyone is different in regards to how long it takes to return to work.

How Old is Too Old?

How old is too old for a new joint replacement? So far, insurance companies have not denied patients joint replacements based solely on their age. A healthy 90 year old may have a longer life expectancy than a 60 year old diabetic with heart disease who smokes. Recommendations for or against surgery should be based on your health and the amount of arthritis in your joint, not on just your age.

Surgical Complications

What about complications? No surgery is without some risk. The majority of people who have knee replacement surgery are very pleased with the outcome and many wish they had chosen to have the surgery sooner. Occasionally, complications such as medical problems (pneumonia, heart attack, blood clots), stiffness of the joint, continued knee pain, implant loosening, implant failure, and infection can occur. However, these complications are rare and over 90% of people are very satisfied with their new knees. Certain activities, such as running are not recommended because of the risk of premature wear and loosening of the implant. Less than 1% of knee surgeries are complicated by infection, but infections can also spread from elsewhere in the body to the metal joint, so prophlaytic antibiotics are sometimes recommended before dental and other medical procedures.

Ask Your Surgeon Questions

If you have been told that you need to have a knee replacement do not be afraid to ask questions. Have you tried all the non operative treatments for arthritis? Are their any options other than surgery? Make sure you are comfortable with the surgeon who will be performing your knee replacement. You should be able to talk to your surgeons about your concerns and fears about joint replacement.

Don’t let fear keep you from doing the things you enjoy in life.

The Evolution of Joint Replacements

Posted on July 7, 2015.

by: Douglas M. Joseph, MD

This year, about 800,000 people in the US will have either a hip or knee replacement. Total hip and knee “survival” or success is estimated by The Academy of Orthopaedic Surgery to be greater than 90% in several twenty-five year follow up studies.

The Evolution of Joint Replacements

We’ve come along way since 1963 when John Charnley, MD started the Total Hip Joint Replacement era when his article titled Low Friction Arthroplasty was published in the British Medical Journal The Lancet. For this work, Dr. Charnley was later knighted by the Queen of England.  

About ten years later at the Hospital for Special Surgery in New York City,  John Insall, MD and Chitranhan Ranawat, MD collaborated on the development of the Total Knee Replacement, as reported in the Journal of Bone and Joint Surgery in 1974.   

We pass on these landmark articles to you to inform you about the historic start of two procedures that have changed the lives of so many patients suffering from hip and knee arthritis.  

Design changes over the years have improved our long term results. No longer is it true that these procedures “only last for ten years.” That was true back in the 1980’s but is now incorrect.  

New Hampshire Orthopaedic Center’s Total Joint Team

We here in the total joint team at New Hampshire Orthopaedic Center specialize in these procedures. We are fellowship trained and keep up with the latest developments in our ever-changing field. You can be confident that you will have the very best care and success when you have your hip or knee replaced by one of our excellent surgeons.   

This month’s journal is dedicated to you, our patients. We want to highlight articles on the American Academy of Orthopaedic Surgeons website that will help you understand the hip and knee replacement procedures you may need to eliminate your pain. 

As we say here at the New Hampshire Orthopaedic Center, “We Keep Bodies In Motion.” 


American Academy of Orthopaedic Surgeons OrthoInfo: 

Total Hip Replacement

Total Knee Replacement

Return to Golf and Tennis After Joint Replacement 

Posted on June 18, 2015.

By: Kathleen A. Hogan, MD

As the last of the snow melts away, thoughts turn away from the ski slopes and towards the golf course and the tennis courts.    Unfortunately, if you have been living with hip or knee pain, these recreational activities may be more painful than pleasurable.    

As a joint replacement surgeon, I treat patients whose pain from arthritis keeps them from participating in activities that they enjoy.  When non-operative treatments no longer provide significant pain relief, joint replacement may be an option.  Hip and knee replacement can be extremely successful in relieving pain from daily activities such as walking, standing, and stair climbing.  But for some people, this is not enough.   They want to get back to playing sports. This article will explore the issues affecting a return to golf and tennis after joint replacement. 

Impact of Activity on an Artificial Joint

Joint replacements can wear out, and high impact activities such as running may cause the artificial joint to wear out faster, possibly leading to further surgery.  However, most joint replacement surgeons allow their patients to resume moderate activity, including golf and doubles tennis.   Golf and tennis do place considerable stresses on the knee with joint reactive forces similar to jogging generated during the swing of a racket or club.   In golf, the leading knee absorbs the most stress, and in tennis the forehand puts more stress on the knees than does a backhand stroke.

Return to Sporting Activity

Return to sporting activity depends on the type of joint replaced. Recovery after a hip replacement is typically faster than after knee replacement.   The direct anterior approach to hip replacement limits muscle damage and speeds recovery.  However, the bone needs to grow into the implant to stabilize it, and I recommend waiting a minimum of 8 weeks before resuming vigorous activities.   Recovery after knee replacement is slower.  More time is needed to recover range of motion and gain strength.  

Impact of Joint Replacement on Athletic Performance

How does joint replacement affect athletic performance? Surveys of small numbers of golfers show small increase in handicap and decreased drive distance.  Most golfers do not walk the course after joint replacement, and instead choose to use a golf cart.  Some notice some mild discomfort during and after playing, but a high percentage of golfers  were able to resume playing the same or increased frequency as before their surgery.  There is limited data on return to play of tennis players, however.

Can I Return to Golf and Tennis After Joint Replacement? 

So, can you return to golf and tennis after joint replacement? The answer is yes.  However, the tennis and golf swings do put considerable force on the joints. It may take time to rehabilitate your muscles to allow you to return to the same level of activity you had before your surgery.  Even after joint replacement your new hip or knee may ache or feel stiff after athletic activity.  However most golfers and tennis players indicate that they are able to continue to enjoy their sports following joint replacement.  If you routinely participate in sporting activities after joint replacement, it is usually recommended that you have an X-ray every 5 years to ensure that there has been no premature wear of the joint.